Specialists, not generalists, taking home more pay

For the first time in five years, an annual survey of physicians in group practices found that primary care physicians received smaller pay raises than specialists in 1996.

All physicians, regardless of their specialty, meanwhile, had to work harder for smaller pay increases, according to a new report from the Medical Group Management Association. Specialists reported increasing their workload, as measured by median gross charges, much more than primary care physicians—10.61%, compared to 3.36% over 1995-96.

Last year, primary care physicians in group practices saw their median compensation rise by 1.42%, compared to 2.58% for specialists. For internists, the 1996 median compensation reported was $140,000, up 0.49% from the previous year; for family practitioners who do not deliver babies, it was $132,434, up about 2%; and for pediatricians, it was $132,039.

For internal medicine subspecialists, the median compensation reported was higher: for noninvasive cardiologists: $247,133; for gastroenterologists: $224,382; for nephrologists: $196,500; for specialists in hematology/oncology: $190,550; for infectious diseases specialists: $150,600.

The highest paid doctors, according to the survey, were cardiovascular surgeons, who reported a median compensation of $545,431.

The survey also found that salaries differed depending on the type of practice the doctor was working in. For instance, those working in southern states earned more regardless of whether they were in primary care or in specialties. For instance, the median income for internists in the South was $145,370, more than that earned by internists working in the East ($138,894), West ($137,867) or Midwest ($137,237). The lowest-paid primary care physicians in general could be found in the East, but the lowest-paid specialists were in the West.

The percent of income derived from at-risk managed care also affected income, according to the study, but differently for primary care physicians and specialists. The highest paid primary care physicians were those with either no revenue earned from managed care or those that had a lot of it—51% to 100% of their revenue. But with specialists, there was a steady drop in median income reported as the amount of managed care revenue increased.

Income also differed depending on whether the doctor was part of a single-specialty or a multi-specialty group. Primary care physicians who were in multi-specialty groups earned slightly more on average than their colleagues in single-specialty groups, whereas the opposite was true for specialists. The median income of specialists in single-specialty groups was markedly higher than those in multi-specialty groups.

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